TREATMENT OF CONGENITAL DUODENAL OBSTRUCTION: FROM OPEN TO LAPAROSCOPIC APPROACH FOR DUODENO-DUODENAL ANASTOMOSIS.

Abstract

Conginental duodenal obstruction is a relatively rare malformation. Laparoscopic operation for this condition was described for the first time in 2001, but more than 20 years later, there is still debate over the preferred method of surgical correction. We believe that laparoscopic correction of conginental duodenal obstruction is a safe and feasible method and can be used in premature infants with low body weight. Materials and Methods: From September 2017 to December 2021, 27 children with conginental duodenal obstruction were treated in our department. We were able to identify the diagnosis in 17 children during the antenatal period, while plain X-ray confirmed postnatal diagnosis. In doubtful cases the contrast fluoroscopy was performed. Four children underwent open correction of the defect via a circumbilical approach, while laparoscopic duodeno-duodenal anastomosis using the Kimura technique was performed in the remaining 23 children. Results: Intraoperative complication in the form of duct injury was observed in 1 patient with an atypically located Wirsung duct. In the postoperative period, anastomotic failure was noted in 2 children, and perforation of the duodenum was detected in 2 patients. The mortality rate comprised 26%, which was partly attributed to severe concomitant pathologies. The use of prolonged epidural analgesia in combination with laparoscopic surgery provided early weaning from mechanical ventilation and transfer from the intensive care unit. Enteral feeding was initiated on postoperative day 5, and the average length of hospital stay was 29±10.5 days. Conclusion: There are no limitations to performing laparoscopic correction of congenital duodenal obstruction. When there are accompanying congenital defects, minimally invasive technology allows to perform combined operations on organs of the thoracic and abdominal cavity, which reduces the overall surgical time. In combination with prolonged epidural analgesia, laparoscopic technique reduces the length of stay in the intensive care unit and the need for parenteral nutrition, which ultimately lowers the risk of inflammatory complications and treatment costs.